Clinical characteristics and risk factors of ureaplasma urealyticum infection in preterm infants in the neonatal intensive care unit

doi:10.11958/20253350

Abstract

Abstract:

Objective To analyze the clinical characteristics and risk factors of ureaplasma urealyticum (UU) infection in preterm infants. Methods A total of 462 preterm infants admitted to the Neonatal Intensive Care Unit (NICU) of Nanyang Central Hospital from January 2023 to January 2025 were enrolled. According to the test results of UU testing of lower respiratory tract secretions was performed within 48 hours after birth, and these infants were divided into the UU positive group of 130 cases and the UU negative group of 332 cases. The general data, laboratory examination indicators, and treatment conditions of the two groups of preterm infants, as well as the pregnancy and perinatal related indicators of their mothers were compared. Multivariate Logistic regression was used to analyze the influencing factors of UU infection, and a combined diagnostic model was established and the receiver operating characteristic (ROC) curve was drawn. Results Compared with the UU-negative group, the UU-positive group of preterm infants had lower gestational age, birth weight, 1-minute Apgar score, 5-minute Apgar score, and platelet (PLT), and higher proportions of infants with acute respiratory distress syndrome, bronchopulmonary dysplasia (BPD), sepsis and intracranial hemorrhage, as well as increased levels of white blood cell (WBC), neutrophil (NEUT), and C-reactive protein (CRP), and longer durations of antibiotic use, mechanical ventilation, and oxygen therapy (P<0.05). Compared with the UU-negative group, the mothers of the UU-positive group had a higher proportion of UU infection history, concurrent chorioamnionitis, premature rupture of membranes, antepartum fever, vaginal delivery, and amniotic fluid grade Ⅲ contamination during pregnancy, and longer duration of labor (P<0.05). There were no statistically significant differences in maternal age, parity, gravidity, conception method, concurrent gestational hypertension and gestational diabetes between the two groups. Multivariate Logistic regression analysis showed that concurrent sepsis, concurrent intracranial hemorrhage, maternal UU infection history, concurrent chorioamnionitis during pregnancy and vaginal delivery were independent risk factors for UU positivity in neonates, while higher birth weight, 5-minute Apgar score and longer duration of antibiotic use were independent protective factors. The area under the receiver operating characteristic (ROC) curve of the combined diagnostic model was 0.949 (95%CI: 0.925-0.968). Conclusion Screening for risk factors of UU positivity in the respiratory tract of preterm infants can enable early identification and reduce the risk of UU infection in preterm infants in the NICU.

Key words: infant, premature, diseases, ureaplasma urealyticum, root cause analysis, ROC curve

CLC Number:

R722.139

Figures/Tables 6

References 25

[1]	Sprong K E, Mabenge M, Wright C A, et al. Ureaplasma species and preterm birth:current perspectives[J]. Crit Rev Microbiol, 2020, 46(2):169-181. doi:10.1080/1040841X.2020.1736986.
[2]	Cai J J, Ying J J, Li J H. Effects of Ureaplasma urealyticum infection on neonates:a meta-analysis[J]. Am J Transl Res, 2024, 16(12):7222-7237. doi:10.62347/YQIQ1947.
[3]	Silwedel C, Laube M, Speer C P, et al. The role of ureaplasma species in prenatal and postnatal morbidity of preterm infants:current concepts[J]. Neonatology, 2024, 121(5):627-635. doi:10.1159/000539613.
[4]	Zhang Z, Wang J, Chen W, et al. Clinical characteristics and current treatment modality of preterm infants with ureaplasma spp. infection[J]. Children (Basel), 2024, 11(10):1202. doi:10.3390/children11101202.
[5]	Yin Y, Ren H, Li J, et al. Integrated placental and neonatal urinary detection of ureaplasma urealyticum:a translational approach to predicting adverse neonatal outcomes[J]. Placenta, 2025, 172:83-88. doi:10.1016/j.placenta.2025.10.018.
[6]	Sarwar H, Hao Q, Zhang J, et al. Clinical significance of Ureaplasma species in bronchopulmonary dysplasia development in preterm infants[J]. Sci Rep, 2025, 15(1):33683. doi:10.1038/s41598-025-18692-6.
[7]	国家卫生健康委员会科技教育司. 涉及人的生命科学和医学研究伦理审查办法(总则)[J]. 护理与康复, 2024, 23(11):80.
	NHC Department of Science,Technology and Education. Measures for ethical review of life science and medical research involving human subjects(general provisions)[J]. Journal of Nursing and Rehabilitation, 2024, 23(11):80.
[8]	陈亿仙, 李秋玲, 蒋永江, 等. 解脲支原体感染新生儿的临床特征分析[J]. 中国妇幼健康研究, 2024, 35(7):73-78.
	Chen Y X, Li Q L, Jiang Y J, et al. Clinical characteristics analysis of newborns with ureaplasma urealyticum[J]. Chin J Woman Child Health Res, 2024, 35(7):73-78. doi:10.3969/j.issn.1673-5293.2024.07.012.
[9]	魏红玲, 邢燕, 周颖, 等. 胎龄小于32周早产儿解脲脲原体肺炎的临床特征分析[J]. 中华预防医学杂志, 2021, 55(2):239-244.
	Wei H L, Xing Y, Zhou Y, et al. Clinical characteristics of Ureaplasma urealyticum pneumonia in preterm infants with gestational age less than 32 weeks[J]. Chinese Journal of Preventive Medicine, 2021, 55(2):239-244. doi:10.3760/cma.j.cn112150-20201208-01432.
[10]	Silwedel C, Speer C P, Glaser K. Ureaplasma-associated prenatal,perinatal,and neonatal morbidities[J]. Expert Rev Clin Immunol, 2017, 13(11):1073-1087. doi:10.1080/1744666X.2017.1381559.
[11]	陈先睿, 钟美珍, 吴夏萍, 等. 早产儿解脲脲原体感染的临床特点分析[J]. 中国妇幼保健, 2021, 36(2):328-332.
	Chen X R, Zhong M Z, Wu X P, et al. Analysis of clinical characteristics of Ureaplasma urealyticum infection in preterm infants[J]. Maternal and Child Health Care of China, 2021, 36(2):328-332. doi:10.19829/j.zgfybj.issn.1001-4411.2021.02.027.
[12]	李洋丽, 袁天明. 围产期解脲脲原体感染的诊治进展[J]. 中国医药科学, 2024, 14(15):52-56.
	Li Y L, Yuan T M. Advances in the diagnosis and treatment of ureaplasma urealyticum infection during perinatal period[J]. China Medicine and Pharmacy, 2024, 14(15):52-56. doi:10.20116/j.issn2095-0616.2024.15.13.
[13]	Ye G Y, Wang K, Gui Q, et al. Ureaplasma urealyticum-derived lipid-associated membrane proteins introduce IL-6,IL-8,and TNF-α cytokines into human amniotic epithelial cells via Toll-like receptor 2[J]. J Zhejiang Univ Sci B, 2018, 19(8):654-661. doi:10.1631/jzus.B1800005.
[14]	Triantafilou M, De G B, Aboklaish A F, et al. Synergic activation of toll-like receptor(TLR) 2/6 and 9 in response to Ureaplasma parvum & urealyticum in human amniotic epithelial cells[J]. PLoS One, 2013, 8(4):e61199. doi:10.1371/journal.pone.0061199.
[15]	毕敬磊, 田茂瑾, 赵培庆, 等. 解脲脲原体LAMPs通过正向调控巨噬细胞M1极化抑制铁死亡机制研究[J]. 中国免疫学杂志, 2025, 41(11):2573-2577.
	Bi J L, Tian M J, Zhao P Q, et al. Ureaplasma spp. LAMPs inhibits ferroptosis by positively regulation of macrophage M1 polarization[J]. Chinese Journal of Immunology, 2025, 41(11):2573-2577. doi:10.3969/j.issn.1000-484X.2025.11.003.
[16]	王燕琼, 曾雅丽, 陈雪雨, 等. 超早产儿解脲脲原体感染及定植状态的临床特征分析[J]. 中国当代儿科杂志, 2024, 26(8):811-816.
	Wang Y Q, Zeng Y L, Chen X Y, et al. Clinical characteristics of Ureaplasma urealyticum infection and colonization in extremely preterm infants[J]. Chinese Journal of Contemporary Pediatrics, 2024, 26(8):811-816. doi:10.7499/j.issn.1008-8830.2403002.
[17]	Sun T, Fu J. Analysis of the clinical features of intrauterine ureaplasma urealyticum infection in preterm infants:a case-control study[J]. Front Pediatr, 2021, 12(9):774150. doi:10.3389/fped.2021.774150.
[18]	Pavlidis I, SpilleR O B, Sammut D G, et al. Cervical epithelial damage promotes Ureaplasma parvum ascending infection,intrauterine inflammation and preterm birth induction in mice[J]. Nat Commun, 2020, 11(1):199. doi:10.1038/s41467-019-14089-y.
[19]	Waites K B, Rudd P T, Crouse D T, et al. Chronic ureaplasma urealyticum and mycoplasma hominis infections of central nervous system in preterm infants[J]. Lancet, 1988, 1(8575/8576):17-21. doi:10.1016/s0140-6736(88)91002-1.
[20]	Jónsson B, Rylander M, Faxelius G. Ureaplasma urealyticum,erythromycin and respiratory morbidity in high-risk preterm neonates[J]. Acta Paediatr, 1998, 87(10):1079-1084. doi:10.1080/080352598750031428.
[21]	中华医学会围产医学分会新生儿复苏学组. 新生儿窒息诊断的专家共识[J]. 中华围产医学杂志, 2016, 19(1):3-6.
	Neonatal Resuscitation Group,Perinatal Medicine Branch of Chinese Medical Association. Expert consensus on diagnosis of neonatal asphyxia[J]. Chinese Journal of Perinatal Medicine, 2016, 19(1):3-6. doi:10.3760/cma.j.issn.1007-9408.2016.01.002.
[22]	Chen X, Huang X, Zhou Q, et al. Association between Ureaplasma urealyticum colonization and bronchopulmonary dysplasia in preterm infants:a systematic review and meta-analysis[J]. Front Pediatr, 2024, 12:1436568. doi:10.3389/fped.2024.1436568.
[23]	陈静. 早产儿解脲脲原体感染与支气管肺发育不良相关性研究[D]. 郑州: 郑州大学, 2021.
	Chen J. The relationship between ureaplasma urealyticum infection and bronchopulmonary dysplasia in premature infants[D]. Zhengzhou: Zhengzhou University, 2021.
[24]	文艺, 张君, 王英俊, 等. 肺部超声评分及血清SP-A、IL-6水平与新生儿呼吸窘迫综合征病情及预后的相关性[J]. 天津医药, 2026, 54(2):173-178.
	Wen Y, Zhang J, Wang Y J, et al. Correlation analysis of lung ultrasound score,serum pulmonary surfactant protein A and IL-6 levels with disease severity and prognosis in neonatal respiratory distress syndrome[J]. Tianjin Med J, 2026, 54(2):173-178. doi:10.11958/20252398.
[25]	Viscardi R M, Magder L S, Terrin M L, et al. Predicting the likelihood of lower respiratory tract Ureaplasma infection in preterms[J]. Arch Dis Child Fetal Neonatal Ed, 2023, 108(3):250-255. doi:10.1136/archdischild-2022-324192.

组别			n	男性				胎龄/周
UU阴性组			332	180（54.22）				32.86±2.91
UU阳性组			130	68（52.31）				30.15±2.47
t或χ²				0.137				6.921^＊＊
组别		出生体质量/g				Apgar评分/分
组别		出生体质量/g				1 min			5 min
UU阴性组		1 895.45±412.36				7.68±1.55			8.85±1.07
UU阳性组		1 456.38±345.72				6.45±1.82			8.12±1.34
t		6.715^＊＊				8.377^＊＊			9.124^＊＊
组别	并发症
组别	急性呼吸窘迫综合征				BPD		败血症			颅内出血
UU阴性组	128（38.55）				55（16.57）		30（9.04）			45（13.55）
UU阳性组	85（65.38）				42（32.31）		25（19.23）			30（23.08）
χ²	27.064^＊＊				13.956^＊＊		9.258^＊＊			6.230^＊

组别			n	男性				胎龄/周
UU阴性组			332	180（54.22）				32.86±2.91
UU阳性组			130	68（52.31）				30.15±2.47
t或χ²				0.137				6.921^＊＊
组别		出生体质量/g				Apgar评分/分
组别		出生体质量/g				1 min			5 min
UU阴性组		1 895.45±412.36				7.68±1.55			8.85±1.07
UU阳性组		1 456.38±345.72				6.45±1.82			8.12±1.34
t		6.715^＊＊				8.377^＊＊			9.124^＊＊
组别	并发症
组别	急性呼吸窘迫综合征				BPD		败血症			颅内出血
UU阴性组	128（38.55）				55（16.57）		30（9.04）			45（13.55）
UU阳性组	85（65.38）				42（32.31）		25（19.23）			30（23.08）
χ²	27.064^＊＊				13.956^＊＊		9.258^＊＊			6.230^＊

组别	n		WBC/ （×10⁹/L）	NEUT/ （×10⁹/L）		PLT/ （×10⁹/L）		CRP/ （mg/L）
UU阴性组	332		10.23±2.85	5.32±1.86		220.45±50.12		3.2（1.5，6.8）
UU阳性组	130		12.85±3.62	7.58±2.15		185.62±45.38		8.5（4.2，15.3）
t或Z			8.208^＊＊	11.227^＊＊		5.103^＊＊		10.325^＊＊
组别		抗生素使用时间/d			机械通气时间/d		氧疗时间/d
UU阴性组		7.8（4.5，12.6）			2.5（1.0，5.8）		9.6（5.3，16.8）
UU阳性组		14.5（8.2，22.3）			6.8（3.2，12.5）		18.5（10.2，28.3）
Z		9.876^＊＊			11.234^＊＊		10.567^＊＊

组别	n		WBC/ （×10⁹/L）	NEUT/ （×10⁹/L）		PLT/ （×10⁹/L）		CRP/ （mg/L）
UU阴性组	332		10.23±2.85	5.32±1.86		220.45±50.12		3.2（1.5，6.8）
UU阳性组	130		12.85±3.62	7.58±2.15		185.62±45.38		8.5（4.2，15.3）
t或Z			8.208^＊＊	11.227^＊＊		5.103^＊＊		10.325^＊＊
组别		抗生素使用时间/d			机械通气时间/d		氧疗时间/d
UU阴性组		7.8（4.5，12.6）			2.5（1.0，5.8）		9.6（5.3，16.8）
UU阳性组		14.5（8.2，22.3）			6.8（3.2，12.5）		18.5（10.2，28.3）
Z		9.876^＊＊			11.234^＊＊		10.567^＊＊

组别		n	母亲年龄/岁			孕次/次	产次/次			受孕方式
组别		n	母亲年龄/岁			孕次/次	产次/次			自然受孕			辅助生殖
UU阴性组		332	29.12±3.85			2（1，3）	1（1，2）			305（91.87）			27（8.13）
UU阳性组		130	28.65±4.32			2（1，3）	1（1，2）			118（90.77）			12（9.23）
Z或χ²			1.083			0.587	0.325			0.146
组别	UU 感染史			孕期并发症
组别	UU 感染史			妊娠期高血压				妊娠期糖尿病				绒毛膜羊膜炎
UU阴性组	65（19.58）			68（20.48）				62（18.67）				45（13.55）
UU阳性组	98（75.38）			32（24.62）				28（21.54）				38（29.23）
χ²	127.418^＊＊			0.941				0.488				15.578^＊＊
组别	胎膜早破				产前发热				分娩方式
组别	胎膜早破				产前发热				阴道分娩		剖宫产
UU阴性组	85（25.60）				25（7.53）				120（36.14）		212（63.86）
UU阳性组	72（55.38）				22（16.92）				95（73.08）		35（26.92）
χ²	36.935^＊＊				9.019^＊＊				51.216^＊＊
组别				产程/h						羊水Ⅲ度污染
UU阴性组				8.2（5.5，12.8）						42（12.65）
UU阳性组				12.5（8.3，18.6）						38（29.23）
Z或χ²				8.976^＊＊						17.937^＊＊